-
[show abstract]
[hide abstract]
ABSTRACT: Extracorporeal membrane oxygenation (ECMO) systems have undergone rapid technological improvements and are now feasible options for medium-term support of severe cardiac or pulmonary failure. Intractable ventricular arrhythmia is a rare but well-established indication for heart transplantation. We report a case of persistent ventricular fibrillation (VF) that was rescued by insertion of peripheral veno-arterial ECMO during cardiopulmonary resuscitation, which provided support for 30 h of continuous VF and subsequently permitted urgent heart transplantation.
European Journal of Heart Failure 03/2010; 12(3):301-4. · 4.90 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the echocardiographic, functional, and quality of life improving effects of passive containment surgery using the CorCap cardiac support device (CSD; Acorn Cardiovascular Inc., St. Paul, MN, USA) in patients with dilated cardiomyopathy and to investigate the possible differences in ischemic versus idiopathic (i.e., normal angiograms) cardiomyopathy.
Twenty patients with dilated cardiomyopathy (10 with ischemic and 10 with idiopathic disease) were subjected to application of the cardiac support device, between June 2001 and October 2006. Preoperatively and at follow-up cardiac dimensions, cardiac function, functional capacity, and quality of life were evaluated. Follow-up is complete with a mean follow-up time of 32 +/- 5 months.
All patients survived the surgery; four patients died during the follow-up time. Following surgery, there was a significant reduction in cardiac dimensions, improved functional capacity, and improved quality of life. No significant differences could be seen between patients with ischemic versus idiopathic disease.
Application of the CSD is safe and simple in patients with dilated cardiomyopathy and without any apparent negative effects. Further studies are needed to identify optimal patient selection criteria as well as optimal timing of surgery and to assess the long-term effects of this treatment.
Journal of Cardiac Surgery 07/2009; 25(1):107-12. · 0.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the influence on circulating plasma levels of natriuretic peptides following passive containment surgery in heart failure patients with dilated cardiomyopathy, thirteen patients with dilated cardiomyopathy subjected to cardiac surgery received the Acorn Cardiac Support Device. Patients with ischemic cardiomyopathy (n=7) underwent coronary artery bypass surgery receiving 2-3 bypass grafts. In the idiopathic cardiomyopathy group (n=6), mitral valve plasty was performed in five patients while one patients received the Cardiac Support Device only. Circulating plasma atrial natriuretic peptide, brain natriuretic peptide and C-type natriuretic peptide were measured in all patients before surgery and 12 months postoperatively. Following surgery there was a significant decrease in circulating plasma levels of brain natriuretic peptide (0.14+/-0.04 ng/ml vs. 0.06+/-0.03 ng/ml, P<0.05). No significant changes were seen in circulating plasma levels of atrial natriuretic peptide or C-type natriuretic peptide. NYHA functional class improved (2.7+/-0.1 vs. 1.8+/-0.2, P<0.001). The 6-min-walk increased (354+/-35 m vs. 473+/-31 m, P<0.01). There was a decrease in left ventricular end diastolic diameter (73+/-2 mm vs. 65+/-2 mm, P<0.001) and left ventricular end systolic diameter (65+/-2 mm vs. 56+/-3 mm, P<0.01). Following passive containment surgery using the ACORN Cardiac Support Device functional improvement and reversed remodelling is accompanied by decreased BNP levels.
Interactive cardiovascular and thoracic surgery 12/2008; 8(2):191-4.
-
[show abstract]
[hide abstract]
ABSTRACT: After valve replacement in patients with aortic regurgitation short-term and long-term improvement of left ventricular function are related to early reduction of left ventricular dilatation. This case-control study was conducted to investigate the potential beneficial effects by concomitant application of the Acorn Cor Cap Cardiac Support Device (Acorn Cardiovascular Inc, St. Paul, MN) on reduction of ventricular dilatation in patients with aortic regurgitation and advanced ventricular dilatation undergoing aortic valve replacement.
Of ten patients with longstanding aortic regurgitation and ventricular dilatation subjected to aortic valve replacement using mechanical valve prostheses, five were in addition subjected to application of the Cardiac Support Device (Acorn). Cardiac function and dimensions were measured by echocardiography preoperatively and 3 and 12 months postoperatively.
After aortic valve replacement, there was a rapid and sustained decrease in end-diastolic and end-systolic diameters (before operation 72 +/- 4 and 54 +/- 8 mm, to 54 +/- 10 and 40 + 11 mm at 3 months; and 53 +/- 9 and 35 +/- 6 mm, 12 months after operation). This did not differ after Cardiac Support Device (Acorn) application (before operation 74 +/- 1 and 56 +/- 5 mm; 52 +/- 8 and 39 +/- 9 mm, 3 months after operation; and 54 +/- 6 and 39 +/- 8 mm, at 12 months). The left ventricular ejection fraction remained unchanged in both groups.
Application of the Acorn Cor Cap Cardiac Support Device in patients with aortic regurgitation and severe ventricular dilatation does not influence reverse remodeling or cardiac function compared with aortic valve replacement alone.
The Annals of thoracic surgery 09/2007; 84(2):510-3. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Levosimendan is a calcium sensitizer with a positive inotropic effect without increasing oxygen consumption. We have evaluated the immediate effects of levosimendan on cardiac index when given peri-operatively to patients with dilated cardiomyopathy in conjunction with passive containment surgery.
Ten patients with dilated cardiomyopathy undergoing passive containment surgery with the ACORN Cardiac Support Device, either as the sole procedure or in combination with other open heart surgery, were after anaesthesia induction given levosimendan as a bolus dose of 12 microg/kg followed by an infusion of 0.1microg/kg/min for 24 hours. Cardiac index were measured before extra corporal circulation, immediately after extra corporal circulation, at arrival to the intensive care unit and on post operative day 1. The need for inotropic support was recorded.
Nine of ten patients were preoperatively in a low cardiac output situation. At postoperative day 1 there was a significant increase in cardiac index from 2.1+/-0.1 to 2.8+/-0.2.
This study confirms the theoretical benefits of levosimendan judged by an immediate significant positive effect on cardiac index.
Scandinavian Cardiovascular Journal 07/2007; 41(3):197-200. · 0.93 Impact Factor
-
The Journal of thoracic and cardiovascular surgery 07/2006; 131(6):1400-1. · 3.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the influence on circulating levels of endothelin-1 and big endothelin-1 in relation to echocardiographic findings and functional assessment, by passive containment surgery in heart failure patients with dilated cardiomyopathy.
Thirteen patients with dilated cardiomyopathy subjected to cardiac surgery received the Acorn Cardiac Support Device. Patients with ischemic dilated cardiomyopathy (n=6) underwent coronary artery bypass surgery receiving one to three bypass grafts. In the idiopathic dilated cardiomyopathy group (n=7), mitral valve plasty was performed in five patients while two patients received the cardiac support device only. Circulating plasma levels of endothelin-1 and big endothelin-1 were measured in all patients before surgery and 12 months after surgery. Concomitantly New York Heart Association functional class and 6-min walk were evaluated and cardiac dimensions measured with echocardiography.
Following surgery there was a significant decrease in circulating plasma levels of endothelin-1 (5.9+/-0.6 pM preoperatively vs 4.3+/-0.3 pM postoperatively, P<0.05). New York Heart Association functional class improved (2.8+/-0.2 preoperatively vs 1.8+/-0.2 postoperatively, P<0.05). The 6-min walk increased (384+/-24 m preoperatively vs 465+/-33 m postoperatively, P<0.05). There was also a decrease in left ventricular end diastolic diameter (69+/-2mm preoperatively vs 62+/-2mm postoperatively, P<0.05) and left ventricular end systolic diameter (60+/-2mm preoperatively vs 54+/-3mm postoperatively, P<0.05). Linear correlation revealed a relationship between decreased left ventricular end diastolic diameter and decreased endothelin-1 levels (R=0.56; P<0.05).
Following passive containment surgery using the Acorn Cardiac Support Device there is a decrease in circulating levels of endothelin-1 concomitant with a decrease in cardiac dimensions and function improvement.
European Journal of Cardio-Thoracic Surgery 03/2006; 29(3):299-303. · 2.55 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In the present report we describe that NG-monomethyl-L-arginine acetate, a non-specific nitric oxide synthesis inhibitor, administered at 1 mg kg(-1) h(-1) to a patient with critical hypotension following mitral valve surgery combined with passive containment surgery, increased the urinary output and arterial blood pressure while the need for noradrenaline was rapidly attenuated. Again increasing the noradrenaline infusion in the presence of NG-monomethyl-L-arginine acetate caused a dramatic increase of the blood pressure.
European Journal of Heart Failure 01/2006; 7(7):1180-2. · 4.90 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To echocardiographically evaluate the effects of passive containment surgery using the CorCap Cardiac Support Device in heart failure patients with dilated cardiomyopathy.
Twelve patients with dilated cardiomyopathy subjected to cardiac surgery received the Cardiac Support Device. Patients with ischemic cardiomyopathy (n=5) underwent coronary artery bypass surgery receiving 1-3 bypass grafts. In the idiopathic cardiomyopathy group (n=7), mitral valve annuloplasty was performed in five patients while two patients received the Cardiac Support Device only.
Following surgery there was a gradual, sustained improvement in cardiac dimensions (decreased left ventricular end-diastolic diameter and left ventricular end-systolic diameter) combined with an increase in functional status (6-min walk and NYHA class). Concomitantly there was a marked decrease in right ventricular function (decrease in tricuspid annular systolic and diastolic velocities) while the left ventricular function (mitral annular systolic and diastolic velocities) and output (ejection fraction, stroke volume) remained unchanged.
Addition of the Cardiac Support Device to conventional cardiac surgery improves patient status and decreases left ventricular size in heart failure patients with dilated cardiomyopathy. The positive effect on left ventricular dimensions is not accompanied by any improvement in cardiac output but rather right ventricular dysfunction, although the functional significance of this is unclear.
European Journal of Cardio-Thoracic Surgery 10/2005; 28(3):448-53. · 2.55 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 42-year old obese female using contraceptive medication was admitted to the emergency room because of sudden onset of dyspnoea and hypoxia. Computed tomography showed massive pulmonary emboli. Despite initial treatment with thrombolysis her condition deteriorated further and she was referred for acute surgery to our clinic. Before putting the patient to sleep extracorporeal circulation was instituted with access from the groin. After anaesthesia a median sternotomy was performed. With the heart beating, the main pulmonary artery was incised and a 9 cm long thrombus was removed. Immediate weaning from the heart-lung machine was not possible, mainly because of bleeding to the airways. The right atrium and the aorta was therefore cannulated and an extracorporeal circulation membrane oxygenator (ECMO) was used for three days. The patient required several re-entries for bleeding and a tracheotomy during the postoperative course. She was fully recovered three months after the operation.
Lakartidningen 11/2004; 101(44):3420-1.
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the possible beneficial echocardiographic, functional and quality of life improving effects of passive containment surgery using the CorCap Cardiac Support Device in heart failure patients with dilated cardiomyopathy.
Eight patients with dilated cardiomyopathy subjected to cardiac surgery received the Cardiac Support Device. Patients with ischemic cardiomyopathy (n = 4) underwent coronary artery bypass surgery receiving one to three bypass grafts. In the idiopathic cardiomyopathy group (n = 4) mitral valve plasty was performed in two patients while two patients received the Cardiac Support Device only.
All patients survived the surgery and were discharged to home. There was a gradual, sustained improvement in cardiac dimensions (left ventricular end-diastolic diameter, left ventricular end-systolic diameter) and functional improvement (ejection fraction, 6-min walk, NYHA functional class) as well as quality of life. These beneficial effects developed more rapidly and more extensively in the idiopathic cardiomyopathy group.
Addition of the Cardiac Support Device to conventional cardiac surgery, or applied alone, is safe and simple. The device seems to reverse ventricular dilatation and improve functional capacity and well-being of heart failure patients with dilated cardiomyopathy. Further studies will delineate what patient population will best benefit from passive containment surgery using the CorCap Cardiac Support Device.
Scandinavian Cardiovascular Journal 07/2004; 38(3):159-63. · 0.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We hypothesized that cardiovascular performance during the first 24 postoperative hours would be better in patients after off pump coronary artery bypass grafting compared to conventional on pump surgery. Fifty-nine patients were randomized to on or off pump coronary artery bypass grafting. Hemodynamic parameters, including cardiac index and systemic vascular resistance index were measured before and at 1, 4, and 20 h after surgery. Troponin T and creatine kinase-MB (CK-MB) were measured before and at 1, 6, and 20 h after surgery. There was no difference in age, sex, ejection fraction or number of grafts between groups. Cardiac index was higher (p=0.05) and systemic vascular resistance index was lower (p=0.007) in the off pump group 1 h after arrival in the intensive care unit. CK-MB and troponin T were significantly lower in the off pump group after 1 h (CK-MB p<0.001, troponin T p<0.001) and after 6 h (CK-MB p=0.02, troponin T p<0.001). After 24 h there was no difference between the two groups. In conclusion, immediately after surgery there was better cardiovascular performance and less release of markers of myocardial damage after off pump coronary surgery. After 24 h all differences were eliminated.
Interactive cardiovascular and thoracic surgery 12/2003; 2(4):489-94.
